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NPI Code Detail

MEDICARE: AVENUE CARE NURSING AND REHABILITATION CENTER LLC

MEDICARE: AVENUE CARE NURSING AND REHABILITATION CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0050732IL

General Provider Information

NPI Number : 1285956813
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVENUE CARE NURSING AND REHABILITATION CENTER LLC
Provider Business Mailing Address
First Line : 4505 S DREXEL BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4301
Country : US
Telephone Number : 773-285-0550
Fax Number : 773-285-5618
Provider Business Practice Location Address
First Line : 4505 S DREXEL BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4301
Country : US
Telephone Number : 773-285-0550
Fax Number : 773-285-5618
Authorized Official
Title or Position : CEO
Name : JOE ZIMMERMAN
Credential :
Telephone Number : 847-905-4000
Provider Enumeration Date : 02/24/2010
Last Update Date : 02/24/2010

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Directions to “AVENUE CARE NURSING AND REHABILITATION CENTER LLC ” Practice Location

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